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General NPI Number Information
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NPI Number | 1467862383
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Entity Type | Organization
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Legal Business Name | EYE CARE ASSOCIATES OF GROTON LLC
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Dates
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Enumeration Date | 04/30/2014
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Last Update Date | 07/22/2014
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Provider Practice Location Address
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Address Line | 258 ROUTE 12 STE 3
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City | GROTON
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State | CT
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Zip | 06340-3415
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Country | US
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Telephone | 860-445-2200
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Fax | 860-445-2233
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Provider Business Mailing Address
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Address Line | 258 ROUTE 12 STE 3
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City | GROTON
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State | CT
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Zip | 06340-3415
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Country | US
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Telephone | 860-445-2200
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Fax | 860-445-2233
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Authorized Official
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Title or Position | OWNER/OPTOMETRIST
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Name | DR. STEPHANIE T BOREY
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Credential | OD
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Telephone | 860-445-2200
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number |
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License Number State |
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